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Zhou HB, Lu SZ, Yu ZS, Zhang JL, Mei ZN. Mechanisms for the biological activity of Gastrodia elata Blume and its constituents: A comprehensive review on sedative-hypnotic, and antidepressant properties. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 123:155251. [PMID: 38056151 DOI: 10.1016/j.phymed.2023.155251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Insomnia and depressive disorder are two common symptoms with a reciprocal causal relationship in clinical practice, which are usually manifested in comorbid form. Several medications have been widely used in the treatment of insomnia and depression, but most of these drugs show non-negligible side effects. Currently, many treatments are indicated for insomnia and depressive symptom, including Chinese herbal medicine such as Gastrodia elata Blume (G. elata), which has excellent sedative-hypnotic and antidepressant effects in clinical and animal studies. PURPOSE To summarize the mechanisms of insomnia and depression and the structure-activity mechanism for G. elata to alleviate these symptoms, particularly by hypothalamic-pituitary-adrenal (HPA) axis and intestinal flora, aiming to discover new approaches for the treatment of insomnia and depression. METHODS The following electronic databases were searched from the beginning to November 2023: PubMed, Web of Science, Google Scholar, Wanfang Database, and CNKI. The following keywords of G. elata were used truncated with other relevant topic terms, such as depression, insomnia, antidepressant, sedative-hypnotic, neuroprotection, application, safety, and toxicity. RESULTS Natural compounds derived from G. elata could alleviate insomnia and depressive disorder, which is involved in monoamine neurotransmitters, inflammatory response, oxidative stress, and gut microbes, etc. Several clinical trials showed that G. elata-derived natural compounds that treat depression and insomnia have significant and safe therapeutic effects, but further well-designed clinical and toxicological studies are needed. CONCLUSION G. elata exerts a critical role in treating depression and insomnia due to its multi-targeting properties and fewer side effects. However, more clinical and toxicological studies should be performed to further explore the sedative-hypnotic and antidepressant mechanisms of G. elata and provide more evidence and recommendations for its clinical application. Our review provides an overview of G. elata treating insomnia with depression for future research direction.
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Affiliation(s)
- Hai-Bo Zhou
- College of Food Science and Technology, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei Province 430070, China
| | - Sheng-Ze Lu
- College of Food Science and Technology, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei Province 430070, China
| | - Zhong-Shun Yu
- College of Food Science and Technology, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei Province 430070, China
| | - Jiu-Liang Zhang
- College of Food Science and Technology, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei Province 430070, China; Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070, China.
| | - Zhi-Nan Mei
- College of Plant Science & Technology, Huazhong Agricultural University, Wuhan, 430070, China.
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Larson K, Damon M, Randhi R, Nixon-Lee N, J Dixon K. Selective inhibition of soluble TNF using XPro1595 improves hippocampal pathology to promote improved neurological recovery following traumatic brain injury in mice. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-124336. [PMID: 35692164 DOI: 10.2174/1871527321666220610104908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
AIMS To determine the efficacy of XPro1595 to improve pathophysiological and functional outcomes in a mouse model of traumatic brain injury (TBI). BACKGROUND Symptoms associated with TBI can be debilitating, and treatment without off-target side effects remains a challenge. This study aimed to investigate the efficacy of selectively inhibiting the soluble form of TNF (solTNF) using the biologic XPro1595 in a mouse model of TBI. OBJECTIVES Use XPro1595 to determine whether injury-induced solTNF promotes hippocampal inflammation and dendritic plasticity, and associated functional impairments. METHODS Mild-to-moderate traumatic brain injury (CCI model) was induced in adult male C57Bl/6J WT and Thy1-YFPH mice, with XPro1595 (10 mg/kg, S.C.) or vehicle being administered in a clinically relevant window (60 minutes post-injury). The animals were assessed for differences in neurological function, and hippocampal tissue was analyzed for inflammation and glial reactivity, as well as neuronal degeneration and plasticity. RESULTS We report that unilateral CCI over the right parietal cortex in mice promoted deficits in learning and memory, depressive-like behavior, and neuropathic pain. Using immunohistochemical and Western blotting techniques, we observed the cortical injury promoted a set of expected pathophysiology's within the hippocampus consistent with the observed neurological outcomes, including glial reactivity, enhanced neuronal dendritic degeneration (dendritic beading), and reduced synaptic plasticity (spine density and PSD-95 expression) within the DG and CA1 region of the hippocampus, that were prevented in mice treated with XPro1595. CONCLUSION Overall, we observed that selectively inhibiting solTNF using XPro1595 improved the pathophysiological and neurological sequelae of brain-injured mice, which provides support for its use in patients with TBI.
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Affiliation(s)
- Katelyn Larson
- Department of Surgery, Virginia Commonwealth University, United States
| | - Melissa Damon
- Department of Surgery, Virginia Commonwealth University, United States
| | - Rajasa Randhi
- Department of Surgery, Virginia Commonwealth University, United States
| | - Nancy Nixon-Lee
- Department of Surgery, Virginia Commonwealth University, United States
| | - Kirsty J Dixon
- Department of Surgery, Virginia Commonwealth University, United States
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Forstenpointner J, Elman I, Freeman R, Borsook D. The Omnipresence of Autonomic Modulation in Health and Disease. Prog Neurobiol 2022; 210:102218. [PMID: 35033599 DOI: 10.1016/j.pneurobio.2022.102218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
The Autonomic Nervous System (ANS) is a critical part of the homeostatic machinery with both central and peripheral components. However, little is known about the integration of these components and their joint role in the maintenance of health and in allostatic derailments leading to somatic and/or neuropsychiatric (co)morbidity. Based on a comprehensive literature search on the ANS neuroanatomy we dissect the complex integration of the ANS: (1) First we summarize Stress and Homeostatic Equilibrium - elucidating the responsivity of the ANS to stressors; (2) Second we describe the overall process of how the ANS is involved in Adaptation and Maladaptation to Stress; (3) In the third section the ANS is hierarchically partitioned into the peripheral/spinal, brainstem, subcortical and cortical components of the nervous system. We utilize this anatomical basis to define a model of autonomic integration. (4) Finally, we deploy the model to describe human ANS involvement in (a) Hypofunctional and (b) Hyperfunctional states providing examples in the healthy state and in clinical conditions.
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Affiliation(s)
- Julia Forstenpointner
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, SH, Germany.
| | - Igor Elman
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA; Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Guidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:11-27. [PMID: 32799204 DOI: 10.1159/000510696] [Citation(s) in RCA: 378] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria. OBJECTIVE To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature. METHODS PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. RESULTS A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings. CONCLUSIONS The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
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McIntyre A, Mehta S, Janzen S, Rice D, Harnett A, MacKenzie HM, Vanderlaan D, Teasell R. Coping strategies and personality traits among individuals with brain injury and depressive symptoms. NeuroRehabilitation 2020; 47:25-34. [DOI: 10.3233/nre-203081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Danielle Rice
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Amber Harnett
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Heather M. MacKenzie
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Danielle Vanderlaan
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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McIntyre A, Rice D, Janzen S, Mehta S, Harnett A, Caughlin S, Sequeira K, Teasell R. Anxiety, depression, and quality of life among subgroups of individuals with acquired brain injury: The role of anxiety sensitivity and experiential avoidance. NeuroRehabilitation 2020; 47:45-53. [DOI: 10.3233/nre-203080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Danielle Rice
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Amber Harnett
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Sarah Caughlin
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Keith Sequeira
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Rao V, Bechtold K, McCann U, Roy D, Peters M, Vaishnavi S, Yousem D, Mori S, Yan H, Leoutsakos J, Tibbs M, Reti I. Low-Frequency Right Repetitive Transcranial Magnetic Stimulation for the Treatment of Depression After Traumatic Brain Injury: A Randomized Sham-Controlled Pilot Study. J Neuropsychiatry Clin Neurosci 2020; 31:306-318. [PMID: 31018810 DOI: 10.1176/appi.neuropsych.17110338] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. METHODS In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfunction. Exploratory analyses of diffusion tensor imaging pre- and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. RESULTS Small (Hedge's g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. CONCLUSIONS These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.
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Affiliation(s)
- Vani Rao
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Kathleen Bechtold
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Una McCann
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Durga Roy
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Matthew Peters
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Sandeep Vaishnavi
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - David Yousem
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Susumu Mori
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Haijuan Yan
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Jeannie Leoutsakos
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Michael Tibbs
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Irving Reti
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
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Prevention Strategies in Post-TBI Depression in Older Adults: A Case Study. Prof Case Manag 2018; 22:284-290. [PMID: 29016420 DOI: 10.1097/ncm.0000000000000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe a theoretically focused intervention aimed toward chronic stress and depressive symptom management that is coordinated by a case manager and delivered within a home environment by the caregiver. PRIMARY PRACTICE SETTING Home care, community setting. METHODS A case study of an older adult with traumatic brain injury (TBI) secondary to a fall who had significant allostatic load at the time of his injury. "Allostatic load" is a theoretical construct that suggests the brain is experiencing chronic strain on its systems that flexibly respond to stressors. Sustained allostatic load can contribute to chronic conditions and poor outcomes. FINDINGS Through actions with the family as caregivers, the case manager was able to coordinate a structured home setting and gradual resumption of social activities for this older adult. Focus was on establishing structure, meaningful social interactions, and positive home experiences that maximized the older adult's interests and capacity and mitigated chronic stress. Gradually, the older adult returned to his preinjury capacity and lives independently within the family home. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The case management process has the potential to mitigate stressors and improve depression management through family-focused care. Although there is limited guidance on prevention of depression, this approach resulted in attainment of safe home care, no hospital readmissions, and return to previous lifestyle for the older adult. This could be useful in the prevention of post-TBI depression.
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Development and testing of two lifestyle interventions for persons with chronic mild-to-moderate traumatic brain injury: Acceptability and feasibility. Appl Nurs Res 2016; 30:90-3. [DOI: 10.1016/j.apnr.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 11/21/2022]
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Functional magnetic resonance imaging of mild traumatic brain injury. Neurosci Biobehav Rev 2014; 49:8-18. [PMID: 25434880 DOI: 10.1016/j.neubiorev.2014.11.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/02/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022]
Abstract
Functional magnetic resonance imaging (fMRI) offers great promise for elucidating the neuropathology associated with a single or repetitive mild traumatic brain injury (mTBI). The current review discusses the physiological underpinnings of the blood-oxygen level dependent response and how trauma affects the signal. Methodological challenges associated with fMRI data analyses are considered next, followed by a review of current mTBI findings. The majority of evoked studies have examined working memory and attentional functioning, with results suggesting a complex relationship between cognitive load/attentional demand and neuronal activation. Researchers have more recently investigated how brain trauma affects functional connectivity, and the benefits/drawbacks of evoked and functional connectivity studies are also discussed. The review concludes by discussing the major clinical challenges associated with fMRI studies of brain-injured patients, including patient heterogeneity and variations in scan-time post-injury. We conclude that the fMRI signal represents a complex filter through which researchers can measure the physiological correlates of concussive symptoms, an important goal for the burgeoning field of mTBI research.
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Rajeswaran J, Sadana D, Kashyap H. Neuropsychological Rehabilitation. Neuropsychol Rehabil 2013. [DOI: 10.1016/b978-0-12-416046-0.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bay E, Covassin T. Chronic stress, somatic and depressive symptoms following mild to moderate traumatic brain injury. Arch Psychiatr Nurs 2012; 26:477-86. [PMID: 23164404 DOI: 10.1016/j.apnu.2012.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 05/14/2012] [Accepted: 06/01/2012] [Indexed: 11/29/2022]
Abstract
Despite advances in research on symptoms, stress, and depression after traumatic brain injury, there has been limited focus on the collective relationships between neurocognitive performance, chronic stress, and somatic and depressive symptoms. Guided by our adaptation of the allostatic load theory, we examined relationships between chronic stress, somatic and depressive symptoms, and cognitive performance using the Immediate Postconcussion Assessment and Cognitive Testing cognitive battery. Only somatic symptoms and chronic stress explained variation in depressive symptoms (R(2) = .71, P < .0001), not neurocognitive performance, preinjury, or injury-specific variables. Our findings suggest that increased chronic stress and somatic symptoms can contribute significantly to depressive symptoms after mild to moderate traumatic brain injury.
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Affiliation(s)
- Esther Bay
- School of Nursing, University of Michigan, Ann Arbor, MI, USA.
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Bay EH, Blow AJ, Yan XE. Interpersonal relatedness and psychological functioning following traumatic brain injury: implications for marital and family therapists. JOURNAL OF MARITAL AND FAMILY THERAPY 2012; 38:556-567. [PMID: 22804472 PMCID: PMC4898049 DOI: 10.1111/j.1752-0606.2011.00231.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Recovery from a mild-to-moderate traumatic brain injury (TBI) is a challenging process for injured persons and their families. Guided by attachment theory, we investigated whether relationship conflict, social support, or sense of belonging were associated with psychological functioning. Community-dwelling persons with TBI (N = 75) and their relatives/significant others (N = 74) were surveyed on relationship variables, functional status, and TBI symptom severity. Results from this cross-sectional study revealed that only sense of belonging was a significant predictor of postinjury psychological functioning, although interpersonal conflict approached significance. No relevant preinjury or injury-related variables impacted these relationships, except marital status. Our findings suggest that interventions targeting strengthening the injured persons' sense of belonging and lowering interpersonal conflict may benefit those living with TBI.
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Affiliation(s)
- Esther H Bay
- Department of Physical Medicine & Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Suite 300, Ann Arbor, Michigan 48108, USA.
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Bay E, Kalpakjian C, Giordani B. Determinants of subjective memory complaints in community-dwelling adults with mild-to-moderate traumatic brain injury. Brain Inj 2012; 26:941-9. [DOI: 10.3109/02699052.2012.666365] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chronic stress and fatigue-related quality of life after mild to moderate traumatic brain injury. J Head Trauma Rehabil 2012; 26:355-63. [PMID: 21169862 DOI: 10.1097/htr.0b013e3181f20146] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine relationships among chronic stress, fatigue-related quality of life (QOL-F), and related covariates after mild to moderate traumatic brain injury (TBI). DESIGN Observational and cross-sectional. PARTICIPANTS A total of 84 community-dwelling individuals with mild to moderate TBI recruited from multiple out patient rehabilitation clinics assessed on average 15 months after injury. METHOD Self-report surveys and chart abstraction. MEASURES Neurofunctional Behavioral Inventory, Perceived Stress Scale-14, Impact of Events Scale, McGill Pain Short-form Scale, and modified version of the Fatigue Impact Scale. RESULTS QOL-F was associated with somatic symptoms, perceived situational stress, but not with event-related stress (posttraumatic stress disorder symptoms) related to index TBI, preinjury demographic, or postinjury characteristics. Somatic symptoms and chronic situational stress accounted for 42% of the variance in QOL-F. CONCLUSIONS QOL-F in community-dwelling individuals with mild to moderate TBI is associated with chronic situational stress and somatic symptoms. Symptom management strategies may need to include general stress management to reduce fatigue burden and improve quality of life.
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A Cognitive–Representational Approach to Patient Education After Mild Traumatic Brain Injury. Adv Emerg Nurs J 2010. [DOI: 10.1097/tme.0b013e3181e969a5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Bergman K, Bay E. Mild traumatic brain injury/concussion: a review for ED nurses. J Emerg Nurs 2009; 36:221-30. [PMID: 20457317 DOI: 10.1016/j.jen.2009.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/01/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Karen Bergman
- Michigan State University, East Lansing, East Lansing, MI, USA.
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18
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Bay E, Donders J. Risk factors for depressive symptoms after mild-to-moderate traumatic brain injury. Brain Inj 2009; 22:233-41. [DOI: 10.1080/02699050801953073] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Bay E, Xie Y. Psychological and biological correlates of fatigue after mild-to-moderate traumatic brain injury. West J Nurs Res 2009; 31:731-47. [PMID: 19502473 DOI: 10.1177/0193945909334856] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Relationships between chronic perceived stress, cortisol response (area under the curve) and posttraumatic brain injury fatigue were examined with persons from outpatient settings. Seventy-five injured persons with traumatic brain injury and their relatives/significant others participated in this cross-sectional study. Using interviews and self-reported data from the Neurofunctional Behavioral Inventory, the Perceived Stress Scale, the Profile of Mood States-Fatigue subscale, the McGill Pain Scale, as well as self-collection of salivary cortisol over a 12-hour period (N = 50), we found that perceived chronic stress explained 40% of the variance in fatigue until depressive symptoms and pain were in the model. Hypocortisolemia was evident. Somatic symptom frequency and perceived chronic stress represented 50% of the variability in post-TBI fatigue. Fatigue and stress management interventions, as suggested in the Centers for Disease Control Acute Concussion guidelines, may be beneficial in reducing this common symptom.
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Bay E, Sikorskii A, Fuli Gao. Functional Status, Chronic Stress, and Cortisol Response After Mild-to-Moderate Traumatic Brain Injury. Biol Res Nurs 2008; 10:213-25. [DOI: 10.1177/1099800408326453] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is well known that individuals experience difficulties with depressive symptoms and functional status after traumatic brain injury. However, it is unclear what the relationship is between these 2 phenomena and whether there is a biological explanation for. In this secondary analysis, we examined whether depressive symptoms explained postinjury functional status and whether chronic stress and salivary cortisol influenced this relationship. Participants included 75 persons within 24 months of their injury dates who were evaluated or treated in specialty clinics. All participants and a family member or significant other completed survey data, and 50 of the participants provided cortisol data. Results indicated that chronic stress, measured using Cohen's Perceived Stress Scale, completely mediated the relationship between depressive symptoms, measured using the Center for Epidemiological Studies Depression Scale, and psychological functioning, measured using the Patient Competency Rating Scale. Furthermore, those who provided cortisol data displayed hypocortisolemia in their 12-hr profile. Results from this analysis suggest that interventions focused on addressing the chronic stress experience may be important in limiting depressive symptoms and improving psychological functioning. Longitudinal study of this phenomenon is required to understand the progression of chronic stress after traumatic brain injury.
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Affiliation(s)
- Esther Bay
- College of Nursing, Michigan State University, E. Lansing,
Michigan,
| | - Alla Sikorskii
- College of Nursing, Michigan State University, E. Lansing,
Michigan
| | - Fuli Gao
- College of Nursing, Michigan State University, E. Lansing,
Michigan
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Bay E, Hagerty BM, Williams RA. Depressive symptomatology after mild-to-moderate traumatic brain injury: a comparison of three measures. Arch Psychiatr Nurs 2007; 21:2-11. [PMID: 17258103 DOI: 10.1016/j.apnu.2006.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2005] [Revised: 06/16/2006] [Accepted: 07/25/2006] [Indexed: 10/23/2022]
Abstract
Measurement of posttraumatic brain injury depression is problematic. Disagreement exists about the best screening measure, and symptoms of brain injury often overlap those of depression. In an outpatient sample of 75 persons, we compared aspects of Criterion A of the Diagnostic and Statistical Manual of Mental Disorders--Fourth Revision, Text Revision (2000), with three depression subscales: the Neurobehavioral Functioning (NFI-D), Profile of Moods State (POMS-D), and Center for Epidemiologic Studies (CES-D). Nearly 40% of this outpatient sample had significant levels of depressive symptoms. All measures were internally consistent, reliable, and highly correlated. For persons with mild-to-moderate traumatic brain injury, the CES-D was the best screening instrument because of its ease in administration, sensitivity in detecting probable major depressive disorders, its established categories of severity, and its comprehensiveness. Further effort in the establishment of depression severity categories using the NFI-D is needed.
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Affiliation(s)
- Esther Bay
- Michigan State University, College of Nursing, Howell, MI 48843, USA
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22
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23
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Bay E, Kreulen GJ, Shavers CA, Currier C. A New Perspective: A Vulnerable Population Framework to Guide Research and Practice for Persons With Traumatic Brain Injury. Res Theory Nurs Pract 2006; 20:141-57. [PMID: 16758717 DOI: 10.1891/rtnp.20.2.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recovery from traumatic brain injury (TBI) can be a tumultuous lifelong and expensive process. Guided therapies for community integration within community systems are a focus of treating therapists around the world, yet there are no published discussions concerning the most fitting community context. We propose a theoretical approach for practice and research using Flaskerud and Winslow’s conceptual model of vulnerable populations. Using the model constructs of health status, resource availability, and increased relative risk, we offer empirical support for proposed construct relationships applied to persons with traumatic brain injury. We then propose that interventions for health promotion, acute care, and rehabilitation or chronic disease management have a community focus, and we identify relevant goals for community-based practice and research.
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Affiliation(s)
- Esther Bay
- Michigan State University, College of Nursing, E Lansing 48824, USA.
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Alderfer BS, Arciniegas DB, Silver JM. Treatment of depression following traumatic brain injury. J Head Trauma Rehabil 2006; 20:544-62. [PMID: 16304490 DOI: 10.1097/00001199-200511000-00006] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is a common consequence of traumatic brain injury (TBI), and is a source of substantial distress and disability for persons with TBI and their families. This article offers a practical approach to the evaluation and treatment of this condition. Diagnostic and etiologic considerations relevant to this issue are reviewed first. Next, somatic therapies for posttraumatic depression, including antidepressant medications and electroconvulsive therapy, are discussed. Use of these therapies is also considered in the context of the common medical and neurological comorbidities among persons with TBI. Finally, psychosocial interventions relevant to the care of persons with posttraumatic depression are presented.
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Affiliation(s)
- Benjamin S Alderfer
- Brain Injury Rehabilitation Unit, HealthONE Spalding Rehabilitation Hospital, Aurora, Colorado, USA
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25
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Abstract
PURPOSE OF REVIEW The focus of this review is outcome from mild traumatic brain injury. Recent literature relating to pathophysiology, neuropsychological outcome, and the persistent postconcussion syndrome will be integrated into the existing literature. RECENT FINDINGS The MTBI literature is enormous, complex, methodologically flawed, and controversial. There have been dozens of studies relating to pathophysiology, neuropsychological outcome, and the postconcussion syndrome during the past year. Two major reviews have been published. Some of the most interesting prospective research has been done with athletes. SUMMARY The cognitive and neurobehavioral sequelae are self-limiting and reasonably predictable. Mild traumatic brain injuries are characterized by immediate physiological changes conceptualized as a multilayered neurometabolic cascade in which affected cells typically recover, although under certain circumstances a small number might degenerate and die. The primary pathophysiologies include ionic shifts, abnormal energy metabolism, diminished cerebral blood flow, and impaired neurotransmission. During the first week after injury the brain undergoes a dynamic restorative process. Athletes typically return to pre-injury functioning (assessed using symptom ratings or brief neuropsychological measures) within 2-14 days. Trauma patients usually take longer to return to their pre-injury functioning. In these patients recovery can be incomplete and can be complicated by preexisting psychiatric or substance abuse problems, poor general health, concurrent orthopedic injuries, or comorbid problems (e.g. chronic pain, depression, substance abuse, life stress, unemployment, and protracted litigation).
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Affiliation(s)
- Grant L Iverson
- Department of Psychiatry, University of British Columbia, Neuropsychiatry Program, Riverview Hospital, Vancouver, British Columbia, Canada.
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